Pediatrics Apmc

PEDIATRICS BLUEPRINT TOPIC

RECALL

COMPREHENSION

Nephrology

4

3

Respiratory system

3

1

Growth and Development

6

1

Immunization

4

1

Infectious Diseases

17

9

Nutrition

5

2

Digestive system

3

Hematology and Oncology

4

Child Abuse and Poisoning

2 5

Endocrinology/Genetics

1

1

Neurology

1

4

Neonatology

2

9

Cardiology

1

7

Rheumatology

3

Mean MPL: 64.6 % (0.646)

PROBLEM SOLVING

1

CEBU INSTITUTE OF MEDICINE PEDIATRICS 1. Which of the following findings is NOT consistent with physical abuse? A. Implement marks on the torso B. Bruises of varying ages C. Symmetric bruises D. Bruises on the shins, knees and elbows (Answer: D / Reference: A p 1125 / MPL: 0.6) 2. Which of the following is the best way to manage dermal exposure to a potentially toxic substance? A. Wash the exposed area with copious amounts of neutralizing solution B. Wash the exposed are with lots of soap and water C. Wash the exposed area with copious amounts of lukewarm water D. Give oral antidote (Answer: C / Reference: A p 2364 / MPL: 0.6) 3. A 3 year old female was brought to your house because of vomiting, abdominal pain, and nausea. While examining her, you noted that she had a garlic smell emanating from her mouth. What will you do? A. Induce emesis B. Give 6-8 egg whites C. Call an ambulance and bring her to the hospital immediately D. Give activated charcoal (Answer: C / Reference: A p 1426 / MPL: 0.33) 4. Which of the following statements is NOT TRUE regarding nephrotic Syndrome? A. elevated serum triglycerides B. may cause iron deficiency anemia C. normal ionized calcium D. may have decreased intravascular volume (Answer: C / Reference: A p 1755 / MPL: 0.25) 5. Which of the following is NOT a typical course for acute post-streptococcal glomerulonephritis? A. Improvement of the nephritic manifestations can be observed after 1 week of onset B. Hypocomplementenemia resolves after 6 months C. Gross hematuria resolves after 2 months D. Microscopic hematuria may persist for a year (Answer: B / Reference: A p 1740 / MPL: 0.25) 6. Which of the following is NOT TRUE regarding the Hemolytic Uremic Syndrome? A. Associated with thrombocytopenia B. Associated with hematuria C. Responds to steroid therapy D. Can be recurrent (Answer: C / Reference: B p 1746 - 1747 / MPL: 0.33) 7. Which substance is being tested in the Philippine Newborn Screening for Congenital Adrenal Hyperplasia? A. Progesterone B. 17 OH pregnenolone C. !7 OH progesterone D. 11 B hydroxylase (Answer: C / Reference: B 1912 / MPL: 0.6) 8. Which of the following syndromes is associated with elevated growth hormone levels? A. Sotos syndrome B. Laron syndrome C. Klinefelter’s syndrome D. Marfan’s syndrome (Answer: B / Reference: B p. 1848 / MPL: 0.25) 9. Which of the following is the drug of choice for complex partial seizures?

A. Carbamazepine B. Phenytoin C. Phenobarbital D. Diazepam (Answer: A / Reference: B p. 2003 / MPL: 0.9) 10. A 700 gm infant presents with abdominal distention, excessive gastric residuals and bloody stools. Physical examination reveals lethargy, poor perfusion and recurrent apnea. Abdominal examination reveals tenderness, guarding and erythema. You suspect necrotizing enterocolitis (NEC). Of the following, the MOST accurate statement about NEC is that: A. age at onset is inversely related to gestational age at birth B. it is more common among critically ill than convalescing neonates C. pneumatosis intestinalis is the earliest radiographic sign D. strictures that occur as a late complication appear most frequently in the ileum (Answer: A / Reference: B pp. 590 - 591 / MPL: 0.6) 11. A one month old infant was noted to have a small fontanel. Presence of persistently small fontanel is seen in all of the following conditions, EXCEPT: A. cranio synostosis B. congenital hyperthyroidism C. congenital rubella syndrome D. wormian bones (Answer: C / Reference: B p. 525 / MPL: 0.33) 12. An infant is born full term to a woman who had an uncomplicated pregnancy. Immediately after delivery, the infant has severe respiratory failure. Breath sounds are diminished bilaterally. The abdomen is flat. The CXR shows a multicystic mass in the left chest with a shift of the mediastinum to the right. What is the most likely diagnosis? A. Congenital lobar emphysema B. Diaphragmatic hernia C. Respiratory distress syndrome D. Persistence of fetal circulation (Answer: B / Reference: B pp. 1353 - 1355 / MPL: 0.6) 13. A mother is first seen at 28 weeks gestation with severe preeclampsia. A decision is made to deliver the infant. At birth the infant is placed in 100% oxygen. The first arterial blood gas reveals that the infant is hypoxic and has elevated PCO2. Which of the following immediate diagnostic and therapeutic plans is considered the least priority? A. chest radiograph B. exogenous surfactant C. provide mechanical ventilation D. provide volume expansion (Answer: D / Reference: B pp. 570 - 572 / MPL: 0.6) 14. An infant born at 30 weeks gestation begins to experience apnea on the second day of life. Which of the following is the least appropriate initial management option for this infant? A. therapy with theophylline B. evaluation of evidence of hypoxia, infection or intracranial hemorrhage C. CBC, arterial blood gas studies, plasma glucose and electrolyte measurement D. Check that the environmental temperature is in the neutral thermal zone (Answer: A / Reference: B pp. 573 - 574 / MPL: 0.33) 15. An infant is born 28 weeks and weighs 1028 grams. The infant is started on enteric feedings at 3 days of age. Three days later, he is not tolerating his feedings. Which of the following signs and symptoms exhibited by the infant is the least specific for neonatal NEC? A. bile-stained gastric fluid B. pneumatosis intestinalis C. abdominal distention D. jaundice (Answer: D / Reference: B pp. 590 - 591 / MPL: 0.6) 16. An infant was born at 26 weeks gestation. The infant is now 8 weeks old and has bronchopulmonary dysplasia and retinopathy of prematurity (ROP). Which of the following statements is NOT TRUE of the pathogenesis and treatment of ROP?

A. its development is related to retinal vessel immaturity and hyperoxia. B. Cryotherapy is the treatment of choice for all stages of disease. C. The retinopathy resolves spontaneously in most infants. D. Myopia is a common sequelae. (Answer: B / Reference: B pp. 2113 - 2114 / MPL: 0.33) 17. An infant in the delivery room is noted to have respiratory movements, but no air is entering the lungs with the mouth closed. Which of the following is the MOST likely diagnosis? A. narcosis B. choanal atresia C. pulmonary hypoplasia D. congenital heart disease (Answer: B / Reference: B 1386 - 1387 / MPL: 0.9) 18. Jaundice is most likely physiologic in a term infant in which one of the following situations? A. jaundice at 12 hrs of age B. serum bilirubin level increasing less than 5mg/dL/day in the first 2 to 4 days C. jaundice at 12 days of age D. direct serum bilirubin greater than 1mg/dL (Answer: B / Reference: B 594 - 595 / MPL: 0.6) C19. A 900 gm infant of 27 weeks gestation developed respiratory distress syndrome and required endotracheal intubation on the 1st day of life. At 36hours of age, the infant developed hypotension, bradycardia, cyanosis and tense anterior fontanel. The most appropriate diagnostic test is: A. EEG B. Echocardiography C. Ultrasound of the head D. Serum coagulation profile (Answer: C / Reference: B pp. 562 - 564 / MPL: 0.6) For Questions 20 to 21: A 3-day-old male neonate was noted to have pallor and jaundice. The baby was otherwise active, with good suck, good urine output. Stools were greenish black in color. There was no hepatosplenomegaly. The mother’s blood type is “O” Rh+ and the baby’s blood type is also “O” Rh +. Coomb’s test was negative. Hemoglobin was 11 g/dL and reticulocyte count was 7%. The smear showed normocytic normochromic red cells with macrocytes noted. 20. What is the most likely diagnosis? A. Alpha Thalassemia major B. Breastfeeding jaundice C. Glucose 6 phosphate dehydrogenase deficiency D. Physiologic jaundice (Answer: C / Reference: B 1636 - 1638 / MPL: 0.33) 21. Which of the following test would you order next? A. Glucose 6 phosphate dehydrogenase assay B. Hemoglobin electrophoresis C. Hold breastfeeding and give milk formula D. Observation and reassure the mother (Answer: A / Reference: B pp 1636 - 1638 / MPL: 0.33) 22. A 6 hour old term infant delivered spontaneous cephalic was noted to have a swelling over the parietal area which does not cross the suture lines. The swelling pulsates and becomes tense on crying. Which of the following is the most likely diagnosis? A. Caput succedaneum B. Cephalhematoma C. Cranial meningocele D. Molding (Answer: C / Reference: B 1985 - 1986 / MPL: 0.9) B23. Which of the following is the recommended vaccination schedule for neonates born to HBsAg positive mothers? A. Hepatitis B immunoglobulin vaccine within the 12 hours after birth, Hepatitis B vaccine at 1 month, 3 months and 6 months old

B. Hepatitis B Immunoglobulin vaccine at birth and Hepatitis B vaccine at birth, 1 month and 6 months old C. Hepatitis B vaccine at birth, one and six months old D. None since mother is not infectious (Answer: B / Reference: B pp 1328 - 1929 / MPL: 0.6) For questions No 24-27. A 2-year-old male infant was noted to have intermittent episodes of cyanosis. He was noted to assume a squatting position while playing. The mother claimed he was not a “blue baby” at birth and he has no recurrent episodes of cough. 24. A chest x-ray of the patient was done. Which of the following finding would be seen in this patient? A. Boot shaped heart B. Normal heart but with increased pulmonary vascularity C. Heart described as egg on the side D. Left ventricular hypertrophy (Answer: A / Reference: B pp 1524 - 1528 / MPL: 0.9) 25. Which of the following is true regarding the above patient? A. Patient is prone to cerebrovascular event secondary to thrombosis B. Congestive heart failure is a frequent complication C. The problem will resolve spontaneously at 5 years of age D. Bounding pulses is a characteristic feature (Answer: A / Reference: B pp 1524 - 1528 / MPL: 0.6) 26. An electrocardiogram was done on the patient. Which of the following findings would be true in this patient? A. Dominant R waves in the right precordial chest leads B. Left axis deviation C. Negative T waves in V3R and V1 leads D. Peaked R waves in lead II (Answer: A / Reference: B pp 1524 - 1528 / MPL: 0.33) 27. Which of the following drugs is useful in preventing hypoxic spells in the above patient? A. Aspirin C. Captopril B. Dopamine D. Propanolol (Answer: D / Reference: B pp 1524 - 1528 / MPL: 0.6) Questions 28-29. While at school a 6 year old boy is noted by his teacher to experience 10-20 second lapses in consciousness, sometimes with clonic movements of the face. His parents have not noticed this behavior at home. EEG shows 3 per second generalized spike and wave discharges. 28. What is the MOST likely diagnosis of this boy? A. absence seizures C. attention deficit disorder B. complex partial seizures D. generalized tonic clonic seizure (Answer: A / Reference: B pp. 1997 / MPL: 0.6) 29. Which of the following drugs is the MOST appropriate therapy for this boy? A. carbamazepine C. gabapentin B. ketogenic diet D. valproic acid (Answer: D / Reference: B pp 2003 / MPL: 0.6) Question Nos. 30-32. A 1-month-old infant was admitted because of cough and respiratory distress. Pertinent PE findings include rales on both lung fields and a loud continuous murmur. The apical impulse was also noted to be prominent. Pulses were strong. Mother claimed there was no history of cyanosis but she noted that the baby tires easily during feeding. 30. The chest x-ray of the above patient will most likely show which finding? A. left to right shunting with increased pulmonary vascularity B. prominent pulmonary artery with increased pulmonary vascularity C. normal heart with hyperaeration of both lung fields D. right ventricular hypertrophy (Answer: A / Reference: B pp. 1520 - 1512 / MPL: 0.6) B31. Which of the following statements is true in this patient?

A. Right atrial hypertrophy is a most likely consequence B. Blood from the aorta is shunted to the pulmonary artery C. Brain abscess is a frequent complication D. Pressure in the right ventricle is usually decreased (Answer: B / Reference: B pp 1510 - 1512 / MPL: 0.6) 32. Which of the following management is the most applicable in this patient? A. Surgical closure before 1 year of age B. Pharmacologic therapy with indomethacin C. Control the heart failure and do surgical closure at 7 years old D. Surgical closure at 2 years old if there’s no spontaneous closure (Answer: A / Reference: B pp 1510 - 1512 / MPL: 0.33) 33. A previously healthy and developmentally normal 18 month old boy presents with status epilepticus. There is no past or family history of seizures. The child is stabilized and the seizure is halted. Subsequent PE reveals a playful child who has a temperature of 39.2C and nasal discharge. Findings on the remainder of the examination are normal. Which of the following is the most likely cause of the child’s status epilepticus? A. bacterial meningitis C. fever B. cortical dysplasia D. brain tumor (Answer: C / Reference: B pp. 2007 / MPL: 0.6) 34. Which of the following is TRUE regarding benign febrile seizures? A. Peak age of onset is 14 to 18 months B. Associated with high incidence of epilepsy C. Anticonvulsants is indicated to prevent recurrences D. Seizures is typically focal lasting for less than 10 minutes (Answer: A / Reference: B p 1994 / MPL: 0.9) 35. Which of the following is the most appropriate age-independent measure of protein-calorie malnutrition? A. Arm span and reach B. Height for weight ratio C. Weight for age D. Weight for height ratio (Answer: D / Reference: A p 165 / MPL: 0.6) 36. Which of the following is NOT a characteristic of Kwashiorkor? A. Dermatitis B. Edema C. Photosensitive skin D. Lethargy, apathy (Answer: C / Reference: A p 168 - 170 / MPL: 0.9) 37. A patient with Albright’s hereditary osteodystrophy (pseudohypoparathyroidism) sees his physician for an upper respiratory tract infection. This patient has a stocky build with a round face, short stature and brachydactyly of the fourth and fifth metacarpals. Which of the following is also associated with pseudohypoparathyroidism? A. Mental retardation B. Decreased serum parathormone C. Increased serum calcium D. Decreased serum phosphorus (Answer: A / Reference: B pp 1894 - 1895) 38. A 2-year-old child is brought to the emergency room for suspected physical abuse. The physician performs a thorough history and physical examination to determine evidence of maltreatment. Which of the following would be specific evidence of child abuse in this case? A. A blue, non tender macular lesion in the presacral area B. Weight less than the 5th percentile C. Bruised knees D. A circular burn restricted to the buttocks (Answer: D / Reference: A p 1125 / MPL: 0.6) 39. Which of the following is true regarding reporting child abuse incidents?

A. Suspected child abuse should be confirmed before reporting B. Only the attending physician can report a child abuse case C. Child abuse cases should be reported within 48 hours of learning of the case D. Failure to report is punishable by a fine of P500.00 and imprisonment for 1 month (Answer: C / Reference: A p 1119 / MPL: 0.6) 40. Which of the following would indicate Tanner Stage 3 sexual development in females? A. Acne B. Darkly pigmented slightly curly pubic hair C. Fine hair on the upper lip D. Menstruation (Answer: B / Reference: A p 53 - 54 / MPL: 0.6) For question nos. 41 to 46. The 18-month-old daughter of a famous sportsman from Baguio was rushed to the emergency room because of acute onset of fever associated with purpura and lethargy. The extremities were cold and pulses were faint. There was profuse bleeding coming from both nostrils. Meningococcemia with DIC was the consideration. The patient is the 12 th case with meningococcemia in the locality. 41. Which strain of Neisseria meningitidis is mostly likely to be responsible for the disease in the above patient? A. Group A C. Group B B. Group C D Group W (Answer: C / Reference: A p 455 / MPL: 0.33) 42. Which of the following is NOT TRUE regarding the above etiologic agent? A. gram negative diplococci C. obligate intracellular anaerobes B. polysaccharide capsule D. transmitted via respiratory droplets (Answer: C / Reference: B p 896 / MPL: 0.9) 43. Which of the following laboratory findings is NOT consistent with the above patient? A. thrombocytopenia C. Increased fibrinogen B. prolonged PT and PTT D. increased D-dimers (Answer: C / Reference: B pp 896 - 899 / MPL: 0.6) 44. Which of the following additional signs and symptoms is NOT expected to be seen in this patient? A. Pallor C. Peripheral cyanosis B. Hypotension D. Capillary refill time of 2 seconds (Answer: D / Reference: B pp 896 – 899 / MPL: 0.6) 45. Which of the following should be the first management priority in this patient? A. Secure the airway C. Vascular access B. Fluid resuscitation D. Inotropes (Answer: A / Reference: B p 296 / MPL: 0.6) 46. Which of the following antibiotics is NOT appropriate for the above patient? A. Cefotaxime C. Ceftriaxone B. Chloramphenicol D. Cefalexin (Answer: D / Reference: A p 896 - 899 / MPL: 0.6) For questions 47 to 48. A 10 year old girt has a history of easy fatigability, joint pains and swelling of the ankles, high grade fever, systolic murmur at the apex and a positive ASO titer. 47. Which of the following is the correct diagnosis? A. RHD with mitral stenosis B. Acute rheumatic fever with arthritis C. Acute rheumatic fever with carditis and arthritis D. RHD with cardiac tamponade (Answer: C / Reference: B pp. 874 - 879 / MPL: 0.6) 48. Which of the following is the most appropriate management? A. bed rest, diuretics, penicillin B. oxygen, morphine, NSAIDs C. bed rest, steroids, surgery

D. Pen G, bed rest, paracetamol (Answer: D / Reference: A p 874 – 879 / MPL: 0.6) 49. Which of the following is NOT a diagnostic criteria Kawasaki’s disease? A. Polymorphous exanthem B. Bilateral conjunctival injection with exudates C. Spiking fever up to 40 C D. unilateral cervical lymphadenopathy (Answer: B / Reference: B pp 824 - 825 / MPL: 0.6) 50. Which of the following is a sign and/or symptom of congestive heart failure in infants? A. diaphoresis C. feeding difficulties B. neck vein distention D. Bipedal edema (Answer: C / Reference: B p/ 1583 / MPL: 0.6) Questions 51 to 52: .A 5-year-old girl presents at the ER with gross hematuria and periorbital edema. Her BP is 150/95mmHg.The attending physician suspects she has acute postinfectious glomerulonephritis. Urinalysis reveals too numerous to count RBCs and 2+ protein. To confirm the diagnosis, you measure serum complement levels: C3 is 57mg/dl (low) and C4 is 24mg/dl(normal). 51. What is the most common cause of postinfectious glomerulonephritis? A. Staphylococcus aureus C. adenovirus B. group A beta hemolytic strep D. Streptococcus epidermidis (Answer: B / Reference: A p 1743 - 1744 / MPL: 0.6) 52. When do you expect the hypertension to resolve? A. 2 weeks after onset C. 2 months after onset B. 4 weeks after onset D. 1 year after onset (Answer: B / Reference: A p 1743 - 3744 / MPL: 0.6) For question numbers 53 to 54. A 12-year- old boy presents to the emergency department with a 3 day history of tea colored urine that began 2 days following an upper respiratory tract infection. There is no history of dysuria and findings on PE are normal. The family history is negative for any kidney disease. His BP is 115/70mmHg. Urinalysis reveals: sp gravity 1.025; pH 6.0; RBC too numerous to count; 1+ protein; and 0 to 2 WBC. Electrolyte levels are normal. 53. What is the most likely diagnosis? A. Alport syndrome C. immunoglobulin A nephropathy B. focal segmental glomerulosclerosis D. postinfectious glomerulonephritis (Answer: C / Reference: B pp 1737 - 1738 / MPL: 0.3) 54. Which of the following statements is NOT TRUE of the above patient? A. renal function is normal C. more commonly seen in males B. C3 is elevated D. bedrest is part of the management (Answer: B / Reference: A p 1737 - 1738 / MPL: 0.6) 55. Which of the following is true regarding laryngotracheomalacia? A. Stridor is usually expiratory in timing B. Usually resolves by 18 months of age C. Secondary to RSV D. Supine position will diminish the intensity of stridor (Answer: B / Reference: A p 653 / MPL: 0.6) 56. Which of the following is NOT TRUE regarding acute epiglottitis? A. The most common etiologic agent is Hemophilus influenzae B. Examination of the throat may precipitate cardiorespiratory arrest C. Associated with hyperextension of the neck and drooling of saliva D. Steeple sign is seen on lateral neck x-rays (Answer: D / Reference: A p 1406 / MPL: 0.6) 57. What is the ideal weight of an 18 month old female child? A. 7 kg B. 9 kg C. 11 kg

D. 15 kg (Answer: C / Reference: B pp. 31 / MPL: 0.6) 58. Which component of DPT vaccine is highly responsible for the adverse effects after vaccination? A. Diphtheria B. Pertussis C. Typhoid D. Tetanus (Answer: B / Reference: A p 37 / MPL: 0.9) 59. Which of the following is the correct definition of a fully immunized child according to EPI? A. At the age of 1 year, the child should receive 1 dose of BCG, 3 doses of DPT/polio/hepa B and 1 dose of measles B. At the age of 1 year, the child should receive 1 dose of BCG, 3 doses of DPT/polio/hepa B/HiB and 1 dose of measles C. At the age of 1 year, the child should receive 1 dose of BCG, 3 doses of DPT/polio/hepa B/HiB/Pneumococcal and 1 dose of measles D. At the age of 1 year, the child should receive 1 dose of BCG, 3 doses of DPT/polio/hepa B and A and 1 dose of measles (Answer: A / Reference: A p 41 / MPL: 0.9) 60. Which of the following is true regarding Rabies infection? A. The incubation period ranges from 20-180 days B. Pre-exposure prophylaxis consists of a 5 dose vaccine regimen C. Rabies immunoglobulin is indicated for all dog bites D. Associated with 75% mortality rate Reference: B p.1102 MPL: 0.6 61. Which of the following is the most common manifestation of Candidiasis in children? A. Diaper dermatitis B. Pneumonia C. Urinary tract infection D. Otitis media (Answer: A / Reference: A p 1031 / MPL: 0.9) 62. When dealing with bacterial infections, which of the following is the gold standard for diagnosis? A. Serologic testing B. Latex agglutination test C. Viral studies D. Culture and sensitivity (Answer: D / Reference: B p 835 - 837 / MPL: 0.9) 63. The presence of generalized muscular spasm, trismus, opisthotonus, and laryngospasm are characteristic of which etiologic agent? A. Treponema pallidum B. Clostridium tetani C. Bordetella pertussis D. Corynebacterium diphtheriae (Answer: B / Reference: A p 468 - 469 / MPL: 0.9) 64. Which of the following is the drug of choice for the above etiologic agent (No. 63)? A. Penicillin G B. Tetracycline C. Amoxycillin D. Erythromycin (Answer: A / Reference: A p 469; B p 952 / MPL: 0.9) 65. A 7-year-old girl is brought to you for chronic cough, low grade fever and mild weight loss for more than a month. Which of the following is your primary consideration? A. Streptococcus pneumoniae infection B. Pertussis C. Mycobacterium tuberculosis infection

D. Influenza (Answer: C / Reference: A p 503 / MPL: 0.9) 66. Which of the following is NOT a common clinical manifestation of Infection with Hemophilius influenzae? A. Meningitis B. Septic arthritis C. Urinary tract infections D. Epiglottitis (Answer: C / Reference: B pp 905 - 907 / MPL: 0.6) 67. Which of the following is characteristic of roseola iinfantum? A. Macular rash after fever of 3 days duration B. High grad fever and rashes occurring at the onset of fever C. Lymphadenopathy, low grade fever D. Vesiculopustular rashes after defervescence (Answer: A / Reference: B p. 1070 / MPL: 0.9) 68. Which of the following is NOT part of the management of children with Rubeola? A. Antistaphylococcal antibiotics for bronchopneumonia B. Vitamin A supplementation C. Isolation until 4 days after the appearance of rash D. Give Measles vaccination on recovery (Answer: D / Reference: B p 1029 / MPL: 0.9) 69. Which of the following is NOT true regarding mumps? A. Commonly affects the parotid gland B. Infectious up to 5 days after onset of swelling C. 2 doses of MMR vaccine confers full protection D. All males infected with mumps will develop orchitis (Answer: D / Reference: B p. 1036 / MPL: 0.6) 70. Which of the following is TRUE regarding Poliovirus infection? A. OPV administration results in fecal viral excretion for a few days B. OPV can result in vaccine associated paralytic polio C. Mass vaccination requires the use of IPV D. IPV is more potent than OPV (Answer: B / Reference: B p. 1042 / MPL: 0.6) 71. Rubella vaccination is contraindicated in all of the following, EXCEPT? A. Pregnant women B. Women of child-bearing age C. Patients on prednisone D. Patients given chemotherapy (Answer: B / Reference: B p 1033 / MPL: 0.9) 72. A 6 month old infant came in for 4 days moderate grade fever, dry hacking cough and coryza. Koplik spots were seen on examination of the oral cavity. Which part of the oral cavity are the Koplik spots best appreciated? A. opposite the lower canines B. opposite the lower molars C. palate D. peritonsillar areas (Answer: B / Reference: B p 1027 / MPL: 0.9) 73. Lifetime immunity is acquired by recovery from the following viral infection EXCEPT: A. Mumps C. Rubella B. Dengue fever D. Varicella (Answer: B / Reference: B p 1033, 1036, 1061 / MPL: 0.9) 74. A 3-year-old female child who has been receiving chemotherapy for acute lymphocytic leukemia was exposed to her sibling with chicken pox. Mother claimed she was not given immunization. Which prophylactic measure should be administered to this child? A. Varicella vaccine immediately

B. Varicella zoster immunoglobulin immediately C. Oral acyclovir D. None, just isolate the child from the sibling (Answer: B / Reference: A p 1061 - 1062 / MPL: 0.6) 75. Which of the following is NOT true regarding varicella vaccine? A. it should be given intramuscularly B. may be given simultaneously with other vaccines C. Contains a live attenuated strain of varicella virus D. 2 doses are required for children < 12 years old (Answer: D / Reference: C p 680 - 681 / MPL: 0.6) 76. Which of the following is considered the infectious period of varicella? A. 1 day before and 5-7 days after the onset of rash B. 1 week before and 2 weeks after the rash C. during the appearance of the rash and 2 weeks after D. during the prodrome period and 10 days after the disappearance of the rash (Answer: A / Reference: B p 1057 / MPL: 0.6) 77. Which of the following is not an eye sign of avitaminosis A ? A. Bitot’s spots B. Nyctalopia C. Xerophthalmia D. Keratomalacia (Answer: B / Reference: B p. 180 / MPL: 0.9) 78. Which of the following is NOT characteristic of the keratoconjunctivitis caused by Herpes simplex virus? A. painful vesicles on the lids B. enlarged and tender preauricular nodes C. keratomalacia D. fluorescent dendritic ulcers of the cornea (Answer: C / Reference: B p 1053 / MPL: 0.6) For question numbers 79-80. A 2 year old female was brought to the emergency room with high grade fever, and diffuse rash (onset of 5 days ago), and a swollen right hand. The rashes were noted to be vesiculopustular over the trunk, face and extremities. Crusting were noted in some of the lesions. The right hand was noted to swollen, erythematous and tender. CBC showed leukocytosis. 79. Which of the following would be the most appropriate therapeutic measures for the patient? A. Give oral acyclovir B. Give intravenous cephalexin C. Give intravenous acyclovir D. Paracetamol only (Answer: B / Reference: B p. 1061 / MPL: 0.9) C80. Which of the following is the main mode of transmission of the causative agent for the diffuse rashes of the patient? A. Skin to lesion contact B. Oral-fecal route C. Respiratory route D. Local inoculation (Answer: C / Reference: B p 1057 / MPL: 0.9) 81. The most characteristic sign of rubella: A. maculopapular rash on the trunk and extremities B. Discrete rose spots in the soft palate A. Retroauricular, posterior cervical and postoccipital lymphadenopathy C. Branny desquamation (Answer: C / Reference: B p. 1032 / MPL: 0.9) 82.. The cardiac structural defects associated with congenital rubella syndrome: A. patent ductus arteriosus and ventricular septal defect B. atrial septal defect and ventricular septal defect

C. ventricular septal defect and pulmonary artery stenosis B. pulmonary artery stenosis and patent ductus arteriosus (Answer: D / Reference: B p 1033 / MPL: 0.6) 83. Which of the following conditions does not present with fetal infection? A. Rubella B. Rubeola C.Parvovirus B19 infection D. Varicella Zoster virus infection (Answer: B / Reference: B p. 1033, 1050, 1059 / MPL: 0.6) 84. The highest incidence of diarrhea occurs in this age group: A. 0-5 months C. 12-17 months B. 6-11 months D. 18-24 months (Answer: B / Reference: D / MPL: 0.9) 85. The pathogenic mechanism involved in rotavirus diarrhea is: A. loss of monosaccharidases B. mucosal adhesion and invasion C. patchy destruction of the villous epithelium D. production of toxin which increases secretory function (Answer: C / Reference: D / MPL: 0.9) 86. The drug of choice for cholera: A. Cotrimoxazole C. Furazolidone B. Tetracycline D. Metronidazole (Answer: B / Reference: D / MPL: 0.9) 87. The first teeth to erupt are usually the: A. central incisors C. first molars B. lateral incisors D. second molars (Answer: A / Reference: A p 60 / MPL: 0.9) 88. Which of the following senses is most developed in newborns? A. auditory C. taste B. tactile D. visual (Answer: B / Reference: A p 53 - 54 / MPL: 0.6) 89. Visual acuity of 20/20 is achieved by: A. 2 yrs old C. 5 yrs old B. 4 yrs old D. 10 yrs old (Answer: C / Reference: B p. 2084 / MPL: 0.6) 90. A 3 year old can perform all of the following, EXCEPT: A. draws man with 3 parts B. rides a tricycle C. tells little stories about experiences D. helps in simple house task (Answer: A / Reference: A p 112 / MPL: 0.6) 91. A 15 month old is able to do all of the following, EXCEPT: A. seats self in child’s chair B. pats pictures C. attempts to use a spoon D. imitates a vertical stroke (Answer: A / Reference: A p 111 / MPL: 0.6) 92. What is the best stimulus to breastmilk secretion in lactating mothers? A. plenty of fluids and vitamins B. good rest and high caloric intake C. eat more shellfish such as clams and tahong D. frequent sucking and complete emptying of breast (Answer: D / Reference: A p 142 / MPL: 0.9)

93. Irritability, pruritus, painful extremities with brawny swelling, coarse hair, dry skin, seborrhea and increased intracranial pressure is seen in: A. Hypervitaminosis A C. Hypovitaminosis D B. Hypervitaminosis D D. Hypocalcemia (Answer: A / Reference: A p 1135 / MPL: 0.6) 94. A 7-year- old presents with the following manifestations: skin and mucous membrane lesions, conjunctivitis, glossitis, depression and somnolence. What is the most likely deficiency? A. Vitamin B1 C. Vitamin B12 B. Vitamin B6 D. niacin (Answer: B / Reference: B p. 183 / MPL: 0.6) 95. Which of the following can be considered as a (+) Mantoux test? A. A 2 year old boy, no BCG, Mantoux 4mm induration B. A 4 year old girl, (+) BCG, Mantoux 8mm induration C. A 2 month old male infant, (+) BCG, Mantoux 3mm induration D. A 4 year old boy, (+) BCG, Mantoux 12mm induration (Answer: D / Reference: A p 505 / MPL: 0.33) 96. Which laboratory tests are helpful in establishing the etiology of anemia? A. hemoglobin, reticulocyte count, bone marrow exam B. serum iron, CBC, platelet count C. CBC, serum iron, reticulocyte count D. CBC, smear review, reticulocyte count, iron studies (Answer: D / Reference: A p 1065 / MPL: 0.6) 97. Which of the following is NOT a feature of hereditary spherocytosis? A. >20% spherocytes B. sex linked recessive C. splenomegaly D. cholelithiasis (Answer: B / Reference: A p 1620 - 1621125 / MPL: 0.6) 98. Which of the following is NOT a feature of aplastic anemia? A. leucopenia B. thrombocytopenia C. hypoferritinemia D. neutropenia (Answer: C / Reference: A p 1288 – 1289; MPL: 0.9) 99. Which of the following is NOT a favorable prognostic factor of acute lymphoblastic leukemia? A. 5 years old C. Hemoglobin: 11 gms B. female D. absence of CNS leukemia (Answer: C / Reference: A p 1694 - 1696 100. The most important index for protein malnutrition at present is: A. edema C. negative nitrogen balance B. wasting D. slow growth and development (Answer: A / Reference: A p 168 - 169 / MPL: 0.6) END OF EXAMINATION

Legend for the references: A Textbook of Pediatrics and Child Health by del Mundo et al 4th Edition B Nelson’s Textbook of Pediatrics by Behrman 17th Edition C Red Book 26th Edition, 2003 Report of the Committee of Infectious Disease (AAP) D Readings on Diarrhea